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Issues with communication and teamwork are consistently cited as leading causes of preventable adverse outcomes in Obstetrics. Simulation can be used to enhance the effectiveness of communication and team performance. We sought to evaluate interdisciplinary teams' use of key teamwork skills in simulated obstetric emergencies over a two year period.
Beginning in 2010, obstetrical providers (Attendings, Residents, Registered Nurses, Physician Assistants, Certified Nurse Midwives) began attending a one day obstetrical simulation course. The course, now an annual requirement for providers, includes an introduction to the TeamSTEPPS training program along with rotation of an interdisciplinary team through a series of obstetrical emergency scenarios. Teams were evaluated for medical management of the emergency, as well as teamwork. During each course, one complex scenario was filmed (postpartum hemorrhage- year 1, cord prolapse/emergency Cesarean delivery- year 2) and videos were used for debriefing team performance. Videos were reviewed and scored on a 5 point scale using a modified version of the STORC Clinical Teamwork Scale. Teams were evaluated for effectiveness of key skills: SBAR, transparent thinking, directed and closed loop communication, resource allocation, decision making, role clarity, performance as leader/helper, and patient-friendliness. Means/standard deviations and medians/inter-quartile ranges were calculated and compared using Mann Whitney U tests.
A total of 39 videos were viewed by one evaluator. Overall teamwork improved from year 1 to year 2 (3.19±.63 vs. 3.85±.38, p=.004). Improvement was noted in 8/9 teamwork skills (Table).
Interdisciplinary obstetric simulation experiences are an effective way to introduce, model and practice key communication skills and teamwork concepts with groups of providers. Continued efforts to improve interdisciplinary communication and team performance are critical for optimizing patient safety and quality of care in obstetrics.